Managing Diarrhea
Chemotherapy can damage healthy cells such as those that line the interior of the digestive tract. The result can be a disruption in the delicate fluid balance that these cells maintain. Specifically, absorption of fluid from the gastrointestinal (GI) tract back into the body is decreased, and secretion of fluid and electrolytes in the stool is increased. This causes watery bowel movements, otherwise known as diarrhea.
The Challenge of Managing Diarrhea
Diarrhea not only is an inconvenient side effect of cancer treatment, but also can be life-threatening if not adequately managed. It may lead to:
- Dehydration
- Electrolyte imbalance
- Malnutrition due to reduced absorption of nutrients
- Inflammation, pain, or bleeding as a result of the increased frequency of bowel movements
At its extreme, diarrhea can cause the critical electrolytes sodium and potassium to reach dangerously low levels, known as hyponatremia and hypokalemia, respectively. The body continually regulates sodium in order to maintain levels within a narrow range. Diarrhea can disrupt this delicate balance by excreting too much sodium in the stool. Symptoms of mildly low sodium levels include:
- Tiredness
- Disorientation
- Headache
- Muscle cramps
- Nausea
Severely low sodium levels can lead to seizures or coma. Severely low levels of potassium can cause abnormal heart function.
Factors That Make Diarrhea Worse
Some factors may make chemotherapy-related diarrhea worse. For example:
- Damage to the intestines as a result of surgery or radiation may make the GI system more susceptible to irritation.
- Other medications (such as antibiotics), diabetes, irritable bowel syndrome, reduced pancreas function, or other conditions may also worsen diarrhea.
Treating Diarrhea
Diarrhea can be addressed in different ways.
Diet
Several changes in your diet will help reduce the discomfort of diarrhea:
- Avoid foods that irritate the GI system, such as greasy, spicy, or fried foods.
- Avoid milk and milk products because diarrhea may lead to a loss of the enzyme lactase, which breaks down lactose, the sugar found in milk, resulting in temporary lactose-intolerance.
- Because of their high-fiber content, vegetables tend to be difficult to digest and should be avoided during episodes of diarrhea. Cruciferous vegetables, such as cabbage, brussel sprouts, and broccoli, can be particularly problematic.
Your diet should be limited to simple, easy-to-digest foods, and then be expanded as the diarrhea begins to subside.
A diet consisting of bananas, rice, applesauce, toast (called the BRAT diet), and clear liquid is a good starting point. Eventually, you can add pasta without sauce, white-meat chicken without skin, scrambled eggs, and other easily digested foods, as tolerated.
Fluids
Staying hydrated (giving your body plenty of liquids) is very important in the management of diarrhea. You must consume enough clear liquids to make up for the volume of fluids lost due to the diarrhea. This amount is in addition to your usual daily intake.
- You may need to take in three to four liters or more of fluid per day.
- In addition to plain water, you should include fluids that
contain some sugar and salt, such as broth or Gatorade®.
Replacement of fluids with plain water alone can lead to low
levels of salt or calcium in the blood. These can be life-threatening
conditions.
Sometimes side effects signal a serious problem. Find out when to call your doctor about chemotherapy side effects.
Drug Therapy
An example of a drug to be prescribed for chemotherapy-related diarrhea is loperamide (Imodium® or others). Loperamide slows the gastrointestinal system and reduces the amount of fluid lost in the stool. Loperamide is effective for managing mild to moderate diarrhea, though it may not work for severe diarrhea. It is an inexpensive over-the-counter medication available as a pill.
Antidiarrheals
Treat diarrhea:
Learn more about how you can best manage other types of chemotherapy side effects.
UNDERSTANDING CANCER
TREATING CANCER WITH CHEMOTHERAPY
CHEMOTHERAPY SIDE EFFECTS
TREATING CANCER IN OTHER WAYS
TRACKING YOUR TEST RESULTS
UNDERSTANDING INSURANCE AND TAX ISSUES: INSURANCE TIPS
WEB RESOURCES AND ORGANIZATIONS
TOOLS FOR ORGANIZING YOUR CANCER INFORMATION
FOR CAREGIVERS
GLOSSARY OF CANCER TERMS
REGISTER FOR PROGRAMS
FOR HEALTHCARE PROFESSIONALS
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